The purpose of this study is to determine whether a breast-conserving treatment program of limited surgery and definitive radiation offers equivalent local control and survival to mastectomy in patients with early stage breast cancer. After work-up confirms localized disease, patients are randomly assigned to either primary surgery or primary irradiation. Patients treated with mastectomy are offered breast reconstruction. All patients undergo complete axillary node removal; those patients with pathologically positive lymph nodes, and those with negative lymph nodes who are estrogen receptor negative receive chemotherapy.